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PERMITTEE NAME)ADDRESS(7m& Fsdky)VmmWLecafi-tfD(fe t) <br />NAME <br />ADDRESS JSLi1i: 14 G1t1h I; ?iGi; _ <br />. SOX 143U <br />i:3AUh cc <br />FACILITY UsI0 tiORTti Z*CUTH MI <br />LOCATION H kA L I S A L L: C(. <br />y •:nu y r t• s L. u n <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM /NPDE$l <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />I ? n v u <br />(:i?dit Lw) <br />F' - FIab1 <br />rCdL 9 IC CCL <br />NOTE: Resd Instructlor» b4ifore Zompioting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX OF <br />TYP <br /> ANALYSIS E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />` REQUIREMENT <br /> <br /> <br />` SAMPLE <br />ti <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />? <br />T <br /> <br />' SAMPLE <br />L <br /> MEASUREMENT <br /> PERMIT i ?t i h C/ r <br /> REQUIREMENT „ . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />M <br />C <br /> / <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />` . <br />` SAMPLE <br /> MEASUREMENT <br />?.. <br /> PERMIT ?tbPCi:. 1{SsFr.hi ! _K,11 :1:i.n/ <br />Y J J REQUIREMENT AV,- <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT L ALtiVI?:;E <br />REQUIREMENT <br /> <br />1 cerwy under pens ty o Iaw that lhh document and all altathmenu were NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />l <br />I DATE <br />Prepared under my dirrctlon or supereh <br />on <br />n accordsnee with a system designed <br />to assure Choi qualified personnel Property Lather and evaluate the Infossrutlon . <br />-- <br />aubmlttrd. Erred on my Inquiry of the Person or penoen who manage the systerm <br />or those perosm directly resporslble foc gathering the Information. the Information <br />st of m <br />kn <br />wl <br />subndtled h <br />t <br />th <br />b <br />d <br />and b <br />tt <br />r <br />l <br />I <br />d <br />t ! <br />! <br />o <br />e <br />e <br />y <br />o <br />e <br />ge <br />e <br />e <br />, <br />mes arcvro <br />e, an <br />, <br />comple <br />e. <br />I am aware that then: are si <br />nlflont <br />enalti <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />fo <br />wlb <br />lill <br />fabr lnr <br />r <br />tl ` <br /> g <br />P <br />es <br />r <br />m <br />ng <br />o <br />ma <br />en. <br />TYPED OR PRINTED Inrtuding the Possibility of fine and Imprtaonment for knowing vtnlatlons. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Roforenc• uH •ttachmr nts hors) <br />EPA Form 3320-1 (Rev 3.+99) Previous editions may be used <br />This is a 4-pan form. PAGE OF